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Three more human cases of West Nile virus have been identified in Maryland, bringing to five the total number in the state this year, health department officials report.In all five cases, virus tests have been 98 percent positive but will require additional evaluation for final confirmation, a spokesman for Maryland's Department of Health and Mental Hygiene said. "From what we've seen, at this time, the elderly seem to be the most at risk," said spokesman J.B. Hanson.The new cases include a 79-year-old woman from Eastpoint and a 74-year-old man from the Carney area of Baltimore County. Health officials said both were treated and released from Baltimore area hospitals.A 70-year-old Baltimore woman, who was semicomatose when hospitalized earlier this month, is also recovering."They're all showing improvements and doing a little better," Dr. Ross Brechner said.A 63-year-old Baltimore woman who was reportedly diagnosed positive for the West Nile on Sept. 7, has died, but not from the virus, Dr. Brechner said.The first known cases of West Nile virus in the United States were in 1999, when it was discovered in birds near the Bronx Zoo in New York City. It killed seven city residents that year. Since then it has spread down the East Coast, killing numerous birds, which scientists then use to monitor how widespread the virus may become in the District, Maryland and Virginia.A total of 365 birds have tested positive in Maryland, most in Baltimore City and the surrounding area, where more than 250 infected birds have been found, Mr. Hanson said.More than 40 birds have tested positive in the District, and nine in Virginia, with four found in Alexandria and three in Annandale.The virus, transmitted by mosquitoes from birds to people and animals especially horses earned its name in 1937 when a woman in the West Nile district of Uganda was found to have a disease never before diagnosed. Two dozen human cases have been reported in the United States this year. The first confirmed case was on Sept. 6 and involved a 72-year-old man from Baltimore's Gwynns Falls area. "He's now recovering well," Dr. Brechner said.Anyone over 50 and anyone "with chronic illnesses like those on kidney dialysis or those suffering from HIV and cancer are mostly at risk," said Arlene Stephenson, Maryland deputy secretary for public health.Since its introduction to the United States, the virus has surfaced in 20 states, mostly in the Northeast. Scientists expect it to continue moving south and west, reaching Central America and California by early next year.Birds found to be infected have been concentrated mainly in urban areas. Health officials reason that could be because surveillance appears to be more efficient in highly populated areas.Throughout the region, health officials have moved to eradicate standing pools of water that serve as mosquito breeding grounds. "We want to remind citizens that they can reduce their risk by preventing mosquitoes from breeding around the home," Virginia Health Commissioner Dr. E. Anne Peterson said in July.So far 17 pools of mosquitoes in the state have tested positive for the virus, and preliminary findings suggest that a horse in the state may also be infected.Early spraying for mosquitoes could have helped avert some of the human cases, said Cyrus Lesser, chief of the mosquito control division in Maryland.Right now, mosquito spraying is usually carried out only after the number of these insects has reached a certain threshold, he said. Yesterday's scheduled spraying for mosquitoes in Baltimore was canceled due to a cold front, Mr. Lesser said.Bird populations are expected to surge during the next month because of migration toward the south, which may lead to a spurt in West Nile virus activity, he said. Vaishali Honawar contributed to this report.

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